2-minute Consultation: Dementia: Many Facets, No Cure

Jeannette Yeznach Wick, RPh, MBA, FASCP

Published Online: Friday, February 1, 2008

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Ms. Wick is a senior clinical research
pharmacist at the National Cancer
Institute, National Institutes of Health,
Bethesda, Maryland. The views
expressed are those of the author and
not those of any government agency.

Mention dementia these days,
and you are as likely to hear
a memory joke as you are to
see a fleeting look of fear. Four dementias
are common: Alzheimer's disease
(AD; now affecting approximately 4.5
million Americans1-5), vascular dementia
(VaD), dementia with Lewy bodies
(DLB), and frontotemporal dementia
(FD).6 Irreversible and incurable, dementia
can be almost impossible to categorize
until autopsy; yet, earlier diagnosis
is associated with better prognosis.7-9

Alzheimer's Dementia

AD progresses slowly. Patients often
are aware of faltering short-term memory
and hide it until later stages of AD.
AD patients do not learn, and prompting
is useless. Eventually, disorganized
thinking and often psychotic mood and
personality disorders incapacitate patients.1 Most AD patients live <8 years
after diagnosis; comorbidities shorten
survival.14

Vascular Dementia

Once called multi-infarct dementia,
VaD's risk factors include hypertension,
diabetes, arterial disease, and
smoking.15-17 VaD patients are acutely
aware of their deficits and learn, but
they may recall material only after
hints. VaD impairment plateaus until
another cerebral accident. Gait disorders,
depression, apathy, and mood
and behavioral changes are common.
15,18-20 To prevent VaD, clinicians
use antiplatelet therapy, control hypertension,
and address risk factors.20

Vivid (but not frightening) visual hallucinations
often occur during serious
confusion.26 Capgras syndrome—believing
a significant other is an imposter—is common, as well as apathy,
depression, slowed thought processes,
getting lost easily, insomnia, autonomic
dysfunction, and losing one's
thought midsentence.25 In almost half
of DLB patients, neuroleptic exposure
worsens the PD-like symptoms, increases
cognitive deficits and hallucinations,
and can cause life-threatening
neuroleptic malignant syndrome.26-28

Conclusion

Between 20% and 50% of dementia
patients have mixed dementias.16,29
Clinicians treat mixed-dementia patients
empirically. Currently, several
drugs are available to treat dementia;
none are curative or more than satisfactory
in their effects. Most patients
with dementia end life in an institution.
Perhaps this will not always be the
case.